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California

Getting Food Stamps To Poor Californians Is Surprisingly Difficult

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Getting food stamps to poor Californians is surprisingly difficult

by Cresencio Rodriguez-Delgado and Jackie Botts

LOS ANGELES (CalMatters) — Pressure is increasing on counties to sign up more people for food stamps since the state’s participation rate is one of the lowest in the nation. But greater enrollment may require more money or more state intervention.

In May 2017, the Los Angeles County Board of Supervisors set an ambitious goal: enroll 70,000 new families in food stamps in two years. 

Home to the state’s highest poverty rate and a growing homeless crisis, the county was enrolling just 69% of residents who were eligible for CalFresh, the state’s name for the federal food stamps program. With full participation, the county would have been expected to gain $560 million in federal funding for its poor.

The social services department got to work, doubling down on outreach, simplifying the application process with new technology, and producing data-driven progress reports each month.

Two years later, enrollment had only budged slightly.

“At the end of the day, we only got 3,000 new (households). And that was a lot of work we did,” said Antonia Jiménez, director of the Los Angeles Department of Public Social Services.

California has long struggled to get food stamps to the hungry. The state enrolled just 72% of eligible residents in CalFresh in 2016, the fifth lowest rate in the nation, leaving behind about $1.8 billion in federal funding earmarked for the hungry. 

Increased scrutiny on the participation gap has prompted a debate among state leaders over how much improvement can be gained by pressuring counties to be more efficient and how much will depend on more money for county eligibility workers.

California is one of only 10 states that manage the food assistance program at the county level, with a wide range of application procedures, technologies and staffing levels. Senator Scott Wiener, a San Francisco Democrat, said the root of the state’s participation gap is an application process that varies from “incredibly easy” to “unnecessarily complicated and onerous,” depending on which county you live in.

“It’s really all over the map and short of transferring responsibility of the program to the state, which would be politically very difficult, we should at least have statewide standards in terms of streamlining the application process and improving awareness among our residents,” he said.

A bill by Wiener would have set a goal for California to enroll 95% of eligible households by 2024, but didn’t survive a committee vote on Friday. The legislation would have required the state to oversee improvement plans and provide technical assistance to the state’s 58 counties, while counties would be required to offer applications entirely over the phone. But it included no money for eligibility workers.

As the experience in Los Angeles and other counties suggest, however, increasing efficiency alone may not be enough to achieve the state’s goal. County and state officials, including Wiener, say more state funding is needed. 

The state’s 2019-2020 budget to administer CalFresh was $639 million. Kimberley Johnson, the newly appointed director of the California Department of Social Services, said she will revisit the way CalFresh is funded in next year’s budget.

“It’s one of our huge safety net programs that we know makes a difference at disrupting poverty and that’s critical, so it’s certainly a priority of ours,” she said.

The demand for increased funding comes even though California already spends more on administrative costs for food stamp programs than nearly every other state, according to a recent federal study

Each California food stamp case cost $808 to administer in 2016, compared to the national average of $348. The study also found that states in which counties run the program spent 24% more per case than other states, after controlling for economic, demographic, and policy differences. 

Frank Mecca, executive director of the County Welfare Directors Association of California, said California is simply a much more expensive place to do business. “California is one of the highest cost places in the country,” he said. “Our salaries are higher, the cost of living is higher, workers get more humane benefits.” 

Mecca also said the state estimate that each CalFresh eligibility worker should cost $58.27 per hour, including salaries, benefits and overhead costs, is out of date. The association calculates that counties currently pay about $105 per hour.

CalFresh staffing levels vary significantly by county, as do participation rates. Take Fresno and Contra Costa counties, for example.

The two counties operate their CalFresh programs in the same old-school way. The application involves three separate steps—answering lengthy questions, providing documentary evidence, and participating in an interview during business hours. It takes days to weeks to complete. Neither county has a telephone-only application. And both assign interview times that may or may not conflict with applicants’ schedules.

Yet Fresno County enrolls about 90% of its eligible population in CalFresh, while Contra Costa enrolls less than 60%, according to state data averaged across 2015 through 2017. With full participation, Contra Costa would have been expected to receive an additional $67 million in federal funds for hungry residents in 2017.

Staffing data from the two counties indicates that Fresno has about 1.6 CalFresh workers per 1,000 people eligible compared to just under 1 per 1,000 in Contra Costa, based on state estimates of the eligible populations in 2017.

Mecca cautioned that the state’s participation rate data are imperfect and don’t reflect gains made by counties over the last two years. Kathy Gallagher, director of the Contra Costa Employment and Human Services Department, also warned that comparing staffing levels is misleading because the two counties have different business models and client needs. But she acknowledged Contra Costa’s program is understaffed. 

Recently, Gallagher said the county had more than 100 CalFresh interviews scheduled out more than a month, out of compliance with the state’s requirement that eligibility be determined within 30 days of an application.

County resident Eduardo Mendoza, 66, applied for CalFresh in mid-July, but his interview was scheduled for mid-October. Until then, Mendoza said he would continue getting daily free meals at a local soup kitchen.

“I’m patient, you know,” Mendoza said, “I know I’ll survive.”

Mendoza became eligible for CalFresh in June after state lawmakers voted to make the program available to recipients of Supplemental Security Income (SSI), an assistance program for the elderly and disabled. The expansion made 500,000 more people eligible for the program statewide and overwhelmed Contra Costa.

For years, advocates have implored the county to upgrade technology, increase outreach, and above all, hire more staff. A 2015 grand jury report on the county’s underutilization of CalFresh recommended the same.

Counties pay 15% of administrative costs for CalFresh while the state pays 35% and the federal government pays the rest. Each county’s budget is also based on last year’s CalFresh enrollment rather than the total number of eligible people in a county, leaving struggling counties with limited resources to close the gap.

Gallagher said, unlike Contra Costa, other Bay Area counties set aside additional money to support CalFresh to keep up with the high costs of the area. Meanwhile, Contra Costa, struggling with tight budgets and a hiring freeze, didn’t pay its full 15% share of administrative costs in several recent years, reducing the amount of federal and state matching funds it received.

“I think Contra Costa is in the position of many other counties that don’t have local revenue measures that supplement their property tax,” John Gioia, chair of the county Board of Supervisors, said. “Contra Costa County relies on state funding … but the state funding is really not sufficient to do the best job.” 

Outreach workers help man with CalFresh
Elizabeth Ambriz, an outreach worker for the Food Bank of Contra Costa and Solano, helps a man sign up for CalFresh in a Pittsburg health clinic. Photo by Anne Wernikoff for CalMatters

In Los Angeles, county supervisors hoped to add 70,000 new households over two years by increasing efficiency without adding more money. If it had been successful, the Los Angeles participation rate might have grown from 69% to 80% and the county’s poor would have been expected to gain an additional $201 million in federal assistance.

Jiménez speaks proudly of the changes she made. The department mailed people on Medi-Cal, the state’s health insurance for low-income residents, an estimate of their CalFresh benefit if they applied. It targeted outreach to students. It rolled out a new one-and-done call center which allows some people to finish the entire application in a single phone call. It also began texting reminders to people to submit their semi-annual recertification reports. 

The county processed 899,000 CalFresh applications over the two years, but nearly as many families dropped off. One lesson learned: “It wasn’t really getting people in the door that was the problem, the problem was keeping them in the system,” Jiménez said.

Despite adding just 3,000 additional households, county officials say the program was a partial success. One reason is that the number of eligible households dropped statewide during the period because of the strong economy. Had the county kept pace with the state’s enrollment decline, over 40,000 households might have unenrolled over the two years.

Also, officials say the specter of a Trump administration proposal that would jeopardize green cards for legal immigrants deemed likely to use public assistance caused immigrant families to opt out of public benefits. They expect that chilling effect will grow after the Trump administration announced the final so-called “public charge” rule in August (California filed suit against the government days later).

What would it have taken to hit Wiener’s goal of a 95% participation rate? Way more staff, Jiménez said. “But you know, to be honest, I don’t believe in arbitrary goals.”

Even in Fresno, with its high participation rate, Department of Social Services deputy director Linda Du’Chene said her CalFresh program is “grossly underfunded.”

“It’s really about the clients,” Du’Chene said. “More funding means more workers; more workers means more efficiency in our ability to process applications” on time.

Du’Chene said a key to Fresno’s high participation rate is the county’s partnership with more than 50 community organizations that help reach eligible people. Contra Costa and Los Angeles officials said they’ve had less success with outreach through nonprofits.

CalFresh applicant smiles
Jerrene Richardson, a college student, began her CalFresh application at the West Fresno Family Resource Center’s annual back to school event in August. Photo via Jerrene Richardson

The West Fresno Family Resource Center, a community group that helped more than 700 families sign up for CalFresh in 2018, drew over 200 families to its 17th annual back to school event in early August. Organizers kept track of attendee data like primary language spoken, ethnicity, and participation or eligibility in CalFresh. Over 100 families showed a need, according to executive director Yolanda Randles.

“Despite what folks are saying about the economy being great, there are families still suffering,” Randles said. “To be able to go to the grocery store and purchase food, I can’t tell you the impact that has on families.”

Jerrene Richardson, a 20-year-old college student, began her application at the event. Unemployed and living alone, Richardson said she hoped CalFresh could help her move a step closer to being independent.

“I really want to be able to get my own food without any trouble,” she said.

Cresencio Rodriguez-Delgado is a journalist at The Fresno Bee. Jackie Botts is a journalist at CalMatters. This article is part of The California Divide, a collaboration among newsrooms examining income inequity and economic survival in California.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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California

COVID-19 and California’s Housing Crisis: Issues to Watch

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A hand-sanitizing station at a homeless encampment near Oakland city hall. Photo by Anne Wernikoff for CalMatters View Comments

by Matt Levin for CalMatters

CALIFORNIA — As the pandemic forces millions of Californians to adjust to a new reality, the words “housing crisis” provoke previously unthinkable questions: How to shelter in place without a home?

How to self-isolate in an overcrowded apartment? Less than two weeks ago, Gov. Gavin Newsom and California lawmakers were in the throes of tackling the twin issues voters considered the state’s most urgent concerns: the more than 150,000 Californians without a home and the state’s sky-high housing costs.

Legislators were introducing controversial bills to make it easier for developers to build more housing, hoping to ease the crippling shortage economists say have made rents and home prices among the most expensive in the country.

Newsom and local governments were about to square off over how to spend $1 billion in proposed help for the unhoused.

That feels like eons ago. As the COVID-19 pandemic forces millions of Californians to adjust to a new reality, the state’s “housing crisis” already means something different, provoking previously unthinkable questions: 

How do you shelter in place without a home? How do you self-isolate in an overcrowded apartment? How far would a $1,000 stimulus check from the federal government go toward my rent or mortgage payment? 

Here are five rapidly evolving housing issues to watch in the next few weeks, months and, yes, years. 

Issue 1: The state’s housing crisis makes it harder to respond to COVID-19

First, there’s the obvious: how to protect the more than 150,000 homeless Californians from contracting and spreading the virus. 

It’s worth reiterating here that the counts you’re hearing from state officials — 108,000 people sleeping outdoors, 43,000 in shelters — are major underestimates. Not only are those numbers more than a year old, but counting the homeless is an inherently unscientific and imprecise snapshot in time. That means more emergency housing units, money and supplies will be needed than what the official stats might indicate.  

It’s also worth reiterating that other states don’t have to worry as much about this vulnerable population as California, which has the highest number of homeless residents in the country and by far the most living outdoors. Many of those homeless are seniors who have chronic health conditions and are particularly susceptible to COVID-19. 

But there are other dimensions of the housing crisis that are making it tougher for public health authorities here to manage the pandemic. Mostly because it’s so expensive to live here, California is the worst state in the country when it comes to overcrowded housing. 

That presents complications for millions of Californians instructed to stay indoors, especially if a household member is showing symptoms of COVID-19. The Centers for Disease Control and Prevention has recommended that someone who is symptomatic should self-isolate in a “sick room” with a separate bathroom. That may not be an option. 

While the virus presents the most pressing public health risk, researchers are also concerned about the long-term physical and health effects of overcrowding if schools and workplaces remain closed for extended periods. 

“On a daily basis, people are experiencing the crowdedness of their homes for longer periods of time throughout the day,’ said Claudia Solari, who researches housing overcrowding at the Urban Institute. “That kind of longer exposure could be a problem.” 

Solari’s research finds overcrowding can be linked to physical and behavioral problems in children. 

Issue 2: Housing the unhoused amid a pandemic takes an extraordinary — and extraordinarily complicated — effort 

Newsom and local governments have announced unprecedented efforts to get people living outside to move indoors. 

The state released $100 million to local governments for emergency shelter housing, with more likely on the way; purchased more than 1,300 trailers from the Federal Emergency Management Agency to isolate homeless people who are symptomatic; and offered to negotiate leases with more 950 hotels on behalf of counties to get more people off the streets. Two hotels have already been secured in Oakland, providing 393 rooms.

The city of Los Angeles, with the largest homeless population in the state, announced today it would convert 42 city recreation centers to emergency shelters to create 6,000 new beds. 

But as sweeping as many of these actions have been, including many long sought by advocates, the task ahead is daunting and raises tough questions for public health experts and providers of services for the homeless.

“Health and healthcare are impossible to do with homelessness, they’re incompatible,” said Dr. Margot Kushel, a UCSF homelessness researcher.

Kushel points to several difficult-to-manage scenarios that may play out in coming weeks: How to discharge someone from a hospital if they don’t have a home in which to self-isolate? How to immediately house people with substance-abuse disorders without risking their health (an alcoholic could die if immediately cut off from alcohol, for example)? What to do with an encampment if someone starts coughing and running a fever? 

That last question could be especially problematic. Kushel pushes back against the notion that large-scale sweeps may be necessary, arguing that dispersing an encampment would be an even larger public health risk. But she worries that contagion could be a pretext for governments to sweep people off the streets, especially for the Trump administration, which has threatened such action before. 

State models show that 60,000 people who are homeless could be infected by the virus, with up to 20% needing hospitalization. 

Issue 3: Renters and mortgage-holders need lots of help

“I think it’s a huge number,”said Carol Galante, director of the Terner Center for Housing Innovation at UC Berkeley. 

Galante was a high-ranking official in the Department of Housing and Urban Development from 2009 to 2014, as the Obama administration wrestled with the Great Recession. 

Galante said she could easily see this crisis become worse for renters and homeowners with mortgages unless bolder action is taken by the federal and state governments — especially for Californians. 

One simple example: the $1,000 stimulus check some federal lawmakers are pushing for all Americans. That could pretty much cover your rent for the average one-bedroom apartment in Phoenix or Dallas or Atlanta. It would cover less than half of what a one-bedroom costs in San Francisco. 

“I keep thinking of all the people whose incomes have just gone to zero,” said Galante. “Hairdressers, waiters, waitresses — they can’t pay their rent.” 

Newsom has received a flood of criticism from tenant-rights groups for not doing enough to prevent evictions in the wake of the pandemic. An executive order the governor issued this week simply allows local governments to impose an eviction moratorium — if they want to. In places that have imposed a moratorium, renters would have to demonstrate financial harm from the coronavirus crisis to avoid eviction. 

The Trump administration announced a moratorium on foreclosures and evictions for federally backed mortgages on single-family homes. That would not apply to the vast majority of renters. 

Issue 4: Rents and home prices may dip, but that’s not necessarily good news 

Economists are saying the country is likely already in recession, and only the depth and breadth of a downturn are uncertain at this point. The worst-case scenarios — 20% unemployment, widespread layoffs over a prolonged period — are terrifying. Early indications are that jobless claims are reaching record levels already. 

In most recessions, home prices and rents decline alongside falling incomes and wages. If a COVID-19-induced downturn is brief and the economy rebounds like President Trump has predicted, rents and home prices might only dip temporarily. But the possibility of a prolonged drop in housing costs is real. 

Some might see a paradoxical benefit for Californians. Wasn’t the root of the “housing crisis” the fact that rents were too damn high? If housing prices drop, won’t more people be able to buy a house?  

Not really. 

A rapid decline in rents and home values might be beneficial to Californians who can keep steady incomes and stable jobs. But for lower-income earners, especially in the service sector, rents will not drop as fast as their incomes. The state will be more unaffordable, not less. 

Issue 5: If momentum for new home building dries up, trouble lies ahead

If California does enter a prolonged recession, its political leaders may want to look back to the 2010’s for a lesson in what policymakers shouldn’t do. 

While the rest of the economy picked up steam after the Great Recession, homebuilding did not — particularly in places like the Bay Area, which saw an explosion in high-wage jobs. Meanwhile, the state only incrementally replaced funding for government-subsidized low-income housing programs it had slashed during the downturn. 

The result? The housing crisis we were living in before COVID-19 hit: sky-high rents, declining homeownership, widespread gentrification and displacement and rising homelessness. 

Galante, the former HUD official, fears that policymakers may make the same mistakes, just as things like affordable housing funding and zoning reform were finally at the top of the agenda. 

“I think we need to be preparing and thinking about that recovery today, and part of that means doing the hard things,” she said. 

Those hard things? Spending more on low-income housing even if state coffers start to bleed, and reducing the regulations developers face when trying to build. 

Matt Levin is the data and housing writer for CALmatters. His work entails distilling complex policy topics into easily digestible charts.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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Half of Californians Could get Coronavirus, Newsom Warns Trump

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The USNS Mercy, a Navy hospital ship is seen docked at Naval Base San Diego Wednesday, March 18, 2020, in San Diego.

by Judy Linn for CalMatters

In a dramatic and unprecedented move, California issued a mandatory, statewide shelter-in-place order on Thursday after Gov. Gavin Newsom warned 56% of Californians — 25.5 million people — could be infected with coronavirus in the next two months.

The governor’s executive order means the most populous state in the nation will effectively shut down non-essential services — altering daily life for 40 million residents for the indefinite future. It allows Californians to continue to go outside to get food or medicine, to walk their dogs, to care for relatives and friends, to get health care, but generally, the directive is to stay at home. 

LET’S NOT REGRET. LET’S NOT DREAM OF REGRETTING, GO BACK AND SAY, ‘WELL, YOU KNOW WHAT, WE COULDA, WOULDA, SHOULDA.’ NOT WHEN THE DATA ALL POINTS TO WHERE I THINK MOST OF US KNOW WE’RE GOING.” — GOV. GAVIN NEWSOM

The order is legally enforceable, meaning disobeying can result in a misdemeanor with up to $1,000 in fines or six months imprisonment, although Newsom said social pressures will likely be enough to encourage people not to gather in the middle of a public health crisis.

Newsom said he made the difficult decision based on modeling by state health officers and new data related to infection rates in the state. Similar shelter-in-place directives were already being used by a number of Northern California counties and the governor had previously asked seniors to stay home, but Thursday’s action now applies to everyone.

“Let’s bend the curve together,” the governor said in a livestream, referring to the effort to slow the spread of COVID-19 to prevent health facilities from being overwhelmed by patients. “Let’s not regret. Let’s not dream of regretting, go back and say, ‘Well, you know what, we coulda, woulda, shoulda.’ Not when the data all points to where I think most of us know we’re going.” 

The directive was the culmination of swiftly escalating restriction in the face of an even more swiftly escalating peril. In just two weeks, Californians saw social gatherings limited first to 250 people, then only to the young and healthy, then locally outlawed in the Bay Area and some other counties. Sports events were canceled. Disneyland shut down for only the third time in history. Then millions of students were sent home from schools and colleges. Bars were told to issue their last call and restaurant seats emptied out. 

It is unclear for the moment when normalcy will return, and Newsom’s executive order was much broader than many of shelter-in-place orders imposed earlier in the week by some cities and counties. What will remain open are the bare essentials: gas stations, pharmacies, grocery stores, banks and laundromats. Restaurants can offer take-out and delivery. About 500 members of the National Guard will be deployed for humanitarian work to help distribute food.

The governor said social media companies such as NextDoor will begin to provide informational kits to check in on neighbors and loved ones. AmeriCorps and the California Conservation Corps will also ramp up outreach to fight isolation, he said.

“One-pagers so you know what kinds of things you need at home to protect yourself, those that are socially isolated, our seniors struggling with loneliness, as much or more than anything else to make sure we reach out, maybe call five people a day, just check in on them,” Newsom said.  

Newsom said his decision wasn’t made lightly. Rather, it came after weeks of effort in collaboration with the Centers for Disease Control and Prevention to model the spread of the novel coronavirus in California, according to Health & Human Services Secretary Mark Ghaly. 

“And we are very glad we had built that model,” Ghaly said. “It’s put us in a great position with our partners across the state to be prepared for what we are starting to see, which are hospitals with many patients, and patients who are in the ICU and having outcomes that we’ve seen in other countries.” 

Earlier in the day, the governor said he had warned President Donald Trump that more than half of Californians — 25.5 million people — could be infected with coronavirus over the next two months as he sought at least $1 billion in federal aid from congressional leaders.

“If we change our behaviors, that inventory will come down,” Newsom said. “If we meet this moment, we can truly bend the curve to reduce the need to surge, to reduce the need to have to go out and to cobble all those assets together.”

In a letter dated Wednesday, California’s governor requested White House assistance to deploy the USNS Mercy hospital ship to Los Angeles as health officials project the state will fall short of hospital beds needed to handle a surge in COVID-19 cases. In the last 24 hours, the state reported 126 new cases, a 21% increase, and the rate is doubling every four days in some areas. 

“We project that roughly 56 percent of our population — 25.5 million people — will be infected with the virus over an eight week period,” Newsom wrote. 

Newsom also sent a separate letter to the leaders of the U.S. Senate and House of Representatives seeking at least $1 billion in federal funds to support California’s response to the pandemic. The money, he said, is needed to purchase and set up health care facilities that the state projects it will need to treat a flood of patients. This includes using state-run hospitals, mobile hospitals and retrofitting hotels and motels.

The governor also asked for additional congressional support to help families and low-income households cope with the crisis by extending unemployment insurance, increase reimbursement for Medi-Cal, the state’s Medicaid program, suspend work requirements for food stamps as families go hungry and allocate more funding for nutrition programs for children and seniors. 

Newsom also called for loans for small businesses and technology and broadband funding for school districts with high concentrations of families in poverty as schools scramble to adapt to online learning or studying at home.  

State health officials estimate that California hospitals have the capacity to handle a surge of about 10,000 people. However, some models project the state could need twice that, closer to 20,000 extra hospital beds. 

He announced a series of steps being taken to bridge that gap. They include ramping up hospital beds by leasing motels and hotels, borrowing university dorms, staving off hospital closures and asking the federal government for two mobile hospitals in addition to the naval hospital ship.

He announced Seton Medical Center in Daly City, which had been slated for closure by Verity Health Systems, would continue operating and said a second hospital in Southern California would be named on Friday.    

While government officials are conferring with pharmaceutical companies such as Gilead in seeking treatments, Newsom said he “was pleased” to see Tesla’s CEO Elon Musk tweet about the possibility of producing ventilators. Musk said Tesla’s cars contain sophisticated ventilation systems and SpaceX, his spaceflight company, makes life support systems.

“Ventilators are not difficult, but cannot be produced instantly,” Musk replied.

In Newsom’s letter to the president, the governor asked that the naval hospital ship be deployed to Los Angeles because it will free up beds at existing hospitals and health facilities to respond to acute care needs, such as heart attacks and strokes or car accidents. 

Newsom sought to strike a chord with the president’s hometown.

“The population density in the Los Angeles Region is similar to New York City, (and) will be disproportionately impacted by the number of COVID-19 cases,” Newsom wrote.

Judy Linn covers state finances, workforce and economic issues for CalMatters. CalMatters reporter Rachel Becker contributed to this report.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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Ask an Expert: Are California’s Coronavirus Projections Solid?

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Kaiser Permanente Registered Nurse Rosa Aceves conducts a COVID-19 test at a drive up testing location at the Kaiser Permanente Fremont Medical Center in Fremont on March 11, 2020. Photo by Doug Oakley courtesy of Kaiser Permanente View Comments

by Rachel Becker for CalMatters

Gov. Gavin Newsom has said more than half the state could become infected by the novel coronavirus. To make sense of the state’s numbers, CalMatters’ Rachel Becker spoke with Lee Riley, a professor of epidemiology and infectious diseases at the UC Berkeley School of Public Health and chair of the division of infectious diseases and vaccinology.

State models project that more than half of the state could become infected with the novel coronavirus over the next two months, a threat to 22.5 million people that has prompted a statewide order from California Gov. Gavin Newsom to shelter in place except for essential activities.

coronavirus epidemiologist Lee Riley
Lee Riley, professor of infectious diseases at the UC Berkeley School of Public Health

The California Department of Public Health reports that California’s case count has climbed, as of Saturday, to 1,223 confirmed cases and 23 deaths — certainly an underestimate because of limited testing. Reports from across the state indicate that tests are being reserved for the sickest and most vulnerable because of a shortage in testing supplies that followed a slow federal rollout of tests hampered by technical flaws. 

So far, about 25,200 tests have been conducted in California’s commercial, private, and public health laboratories. But nearly 12,700 of those results are still pending — leaving California in a data limbo, without a clear sense for how the epidemic is evolving. 

CalMatters spoke with Lee Riley, a professor of epidemiology and infectious diseases at the UC Berkeley School of Public Health and chair of the division of infectious diseases and vaccinology, to make sense of the numbers. 

Why is the novel coronavirus spreading so far, and so fast? 

We don’t really know why this is happening. But one of the observations being made in China, where they have a lot of experiences now, is that the virus seems to be able to transmit even before someone becomes symptomatic

And then even after an infected person recovers from the illness, they continue to shed the virus up to two weeks to even 20 days. So there’s more opportunity for an infected person to transmit. That’s why I think so many other people get infected — because there’s many more days of infectious period for a person to contract the virus. That may be one of the reasons that it’s spreading so quickly.

I don’t have enough information about the source of the data that the governor is using to make any real comments. It’s not disclosed how those numbers were derived. The projection was probably made on not having the control measures that we currently have [such as Thursday’s shelter in place order]. If we didn’t do anything, then yes, certainly, we could have millions of people getting infected.

But we are doing things. And, I don’t know how people are behaving, but the fact that we’re not seeing the explosive increase in the number of deaths tells me that, number one, the healthcare providers are really doing a good job preventing deaths, and that measures that are being taken right now are working, at some level. 

“THE VIRUS SEEMS TO BE ABLE TO TRANSMIT EVEN BEFORE SOMEONE BECOMES SYMPTOMATIC. AND THEN EVEN AFTER AN INFECTED PERSON RECOVERS FROM THE ILLNESS, THEY CONTINUE TO SHED THE VIRUS UP TO TWO WEEKS TO EVEN 20 DAYS.”

How are the testing delays and shortages affecting those numbers?

One caveat is that these numbers that we’re getting may be somewhat delayed because as you know, the testing is increasing in number, and so there’s a real backlog of the tests. We don’t really know exactly what’s happening now. The numbers that we’re seeing are based on the tests that were done several days ago, and they’re just coming up because [at] a lot of the testing services, there’s a huge backlog right now. 

We don’t know which direction this is going to go. We may see a continued increase, a huge bump in the next several days, but that just means the results are just coming in. 

The governor’s projections that 56% of Californians might become infected, and that 20% might get sick enough to require hospitalization — can you put those numbers into context? Have we ever seen anything like it before?

If that’s true, that would be unprecedented. We always talk about the 1918 influenza epidemic, right? Even compared to that, this would be far greater in terms of the number. Mind you, when we talk about this level of infection, that doesn’t mean that all those people are going to have severe disease. 

The governor’s estimates are that maybe 20% will have disease severe enough to need hospitalization. That would still be a lot of hospitalizations, and that would overwhelm the healthcare infrastructure in California. 

What do you think of the state’s shelter in place directive — can it slow the spread of the epidemic? 

I think so. That is really, probably, the best strategy at this point, short of vaccines or other modalities. That’s what we really need to be doing. 

In Wuhan, in the province of Hubei, which is a large province in China with more people than California, they certainly didn’t have millions of infected people. The epidemic was put under control in about three months. So if we compare what happened in China to what’s happening in California, there’s a huge difference in terms of the projections that have been made. 

Although, one thing that should be stressed is that in China they had much more draconian control measures. They not only restricted international travel — people coming in to China or going out — but also intra-country travel. And so that may have also helped. The U.S. is a big country, and so far, and the U.S. hasn’t restricted intra-country travel, and even within California, we’re not really restricting travel between cities — although that’s probably going to happen anyways because people are being asked to stay in their homes. 

What do you think the future holds?

At some point, we need to start thinking about what we are going to do next year. Is the same thing going to happen again next year? If so, are we going to keep doing the same every year? We don’t know, and I think that’s important. More research needs to be done to really understand about the structure of this virus to see if this is a virus that’s going to become seasonal, or endemic [meaning it’s always around], or disappear, like the first SARS. So those are some of the issues we really need to start thinking about, and start planning for next year, and be prepared for next year. 


Rachel Becker is a reporter with a background in scientific research.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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